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From the Departments of Neurology (Drs. Martin and Solders) and Neurophysiology (Dr. Solders), the Divisions of Infectious Diseases and Clinical Virology (Dr. Sönnerborg), and the Neurogenic Pain Unit (Dr. Hansson), Multidisciplinary Pain Center and Department of Rehabilitation Medicine, Karolinska Institute, Karolinska Hospital, Stockholm, Sweden.
Address correspondence and reprint requests to Dr. Claes Martin, Department of Neurology, Karolinska Institute, Huddinge Hospital, S-141 86 Huddinge, Sweden.
OBJECTIVE: To evaluate thermal and nociceptive function in a prospective, longitudinal study of 49 consecutive HIV-1–infected patients before and at 1, 4, and 8 months after initiation of highly active antiretroviral therapy.
METHODS: Quantitative assessments of thermal perception thresholds for warmth (dWT), cold (dCT), and heat pain (HPT) were performed. CD4+ cell levels in blood and HIV-1 RNA levels in plasma were determined. Depending on the virologic response to treatment, the patients were divided into two groups: responders (37 of 49, 76%) and nonresponders (12 of 49, 24%).
RESULTS: Before treatment, impairment of dWT was found in 26 of 49 patients, of dCT in 33 of 49 patients, and of HPT in 19 of 49 patients. Improvements of perception thresholds for dWT (p < 0.0001), dCT (p < 0.001), and HPT (p < 0.01) were observed after 8 months of treatment in the responder group but not in the nonresponders. Within the responder group, improved thermal perception thresholds was associated with higher pretreatment CD4+ levels than in patients without improvement.
CONCLUSIONS: Virologically successful antiretroviral combination therapy of HIV-1–infected patients has a capacity to improve function of the thermal and nociceptive systems, especially in patients with less advanced immunodeficiency.
Key words: HIV-1—Thermal perception thresholds—HIV-1–related polyneuropathy—Vacuolar myelopathy—Antiretroviral therapy.
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